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See a sample rate comparisonCPT 43238 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Esophagogastroduodenoscopy Flexible Transoral; With Transendoscopic Ultrasound-Guided Intramural Or Transmural Fine Needle Aspiration/Biopsy(S) Esophagus (Includes Endoscopic Ultrasound Examination Limited To The Esophagus Stomach Or Duodenum And Adjacent Structures) (Revised 01/01/2014)
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $204.41 national non-facility rate (2026) · View Medicare rates for 43238 |
| Medicaid Fee Schedule | $172.855 median of the 8 states in the free preview · View Medicaid rates for 43238 |
National average reimbursement for CPT 43238 by major payers:
$324.70
$340.14
$359.53
$399.51
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CPT 43238
5 of 25 sample ratesHigher to lower in this preview
South Austin Surgery Center Ltd
$2,701.00Published rateNewport Surgical Partners LLC, Newport Plaza Surgical Center
$1,607.00Published rateMountain West Surgical Center, LLC
Mountain West Surgical Center LLC
$940.00Published rateColumbus Endoscopy Center, Inc
Columbus Endoscopy Center Inc
$499.00Published rateLisa Koop
Deaconess Hospital Inc
$193.27Published rate
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See a sample payer proposalCPT 43238 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43238 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 43238 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 43235-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; Diagnostic Including Collection Of Specimen(S) Bybrushing Or Washing When Performed (Separate Procedure) (Revised 01/01/2014) |
| 43236-CPT | Moderate | Digestive Tract Scope Exam, Exam Of The Esophagus Stomach And Intestines Using A Scope (Endoscope). The Procedure May Remove A Tissue Sample For Testing (Biopsy) Or Treat Bleeding. |
| 43237-CPT | Moderate | Ultrasound Of Esophagus, Ultrasound (Sound Waves) Taken Of The Esophagus During A Scope Exam (Endoscopy) Of The Digestive Tract. The Procedure May Remove A Sample Of Tissue From The Esophagus For Testing (Biopsy). |
| 43238-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Transendoscopic Ultrasound-Guided Intramural Or Transmural Fine Needle Aspiration/Biopsy(S) Esophagus (Includes Endoscopic Ultrasound Examination Limited To The Esophagus Stomach Or Duodenum And Adjacent Structures) (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43238. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43238 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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